Dangerous Surgery to Save a Life

Considering the tremendous value Judaism places on every moment of life, does Jewish law permit one to undergo surgery that carries a very high risk of death?

A 75-year-old woman is informed that she has severe narrowing of her aortic valve, a diagnosis that carries a very high risk of death within one year. She is also told that while there is surgery that is proven to correct her type of ailment, she is a very poor operative candidate and that she has a high risk of dying on the operating table. Nevertheless, if she survives the surgery for valve replacement, her cardiac problem will be cured and she could live many more years.

Considering the tremendous value Judaism places on every moment of life and the prohibition of shortening life by even moments, does Jewish law permit her to undergo the surgery?

Three hundred years ago, Rabbi Yaakov Reischer (1670-1733)1 was asked whether a critically ill patient with a life expectancy of days, on whom the doctors had given up hope of cure, could undergo an experimental treatment that would either kill him immediately or possibly cure him. He set a modern precedent in Jewish law by permitting a patient to risk the 'short-term' life that he could expect if not treated for a chance at 'long-term' life via a risky attempt at cure.

Rabbi Reischer brought a clear proof from a fascinating story in the Prophets.2 The Assyrian army, not known for its kind treatment of POWs, besieged Jerusalem causing a tremendous famine. Four leprous men were outside the walls of the city and starving to death. "…and they said to each other, 'Why are we sitting here until we die? If we say that we will come into the city, with the famine in the city, we will die there, and if we stay here we will die. So now, now let us go and let us defect to the Aramean camp. If they spare us we will live, and if they kill us we will die.'"

The Talmud3 uses this story to justify risking remaining short-term life for even a small chance of long-term survival. The Talmud asks, "But what of the limited time [that would have been his] that he stands to lose if the physician kills him right away? The answer is that such limited duration of life can be disregarded [in this case]. And how do we know this? It is learned from the story of the four lepers."

How short of a life expectancy justifies gambling one's remaining life on a cure and how remote of a cure may be attempted? There is significant debate regarding how good the odds of cure must be to permit therapy. Opinions range from requiring a greater than 50% chance of cure, to allowing even a "remote" chance of cure. While Rabbi Reischer and the Talmud deal with cases of only a few days life expectancy, 20th century rabbinical experts have clearly explained that even longer periods of time are still considered short-term life in Jewish law.

The leader of early 20th century European Jewry, Rabbi Chaim Ozer Grodzenski (1863-1940), was asked a question regarding dangerous surgery in a patient with a maximal life expectancy of six months. He wrote that based upon the Talmud and the ruling in the Sh'vus Yaakov, "one may attempt dangerous treatment even if there is only a remote chance [of cure]… and it is logical that there is no distinction between short-term life of a few days or a few months".4

Rabbi Moshe Feinstein opines that dangerous therapy is permitted even if there is even a remote chance of cure.

Rabbi Moshe Feinstein (1895-1986), the preeminent American halachic authority, clearly states that any life expectancy less than a year can be considered 'short-term' life. In two responsas eleven years apart, he reiterates his opinion that dangerous therapy is permitted even if there is even a remote chance of cure.5

Some Rabbinic authorities require that the treatment be known to be efficacious for the patient's illness. There is an important distinction between a therapy that is known to work but is very risky and one that is completely experimental with no reason to believe that the risk promises any benefit. In the first situation, the treatment is known to be appropriate, but dangerous. In the second situation, we do not even know if the risky treatment could possibly work.

A fascinating related question is whether one may risk his life for relief of extreme pain from a condition that is not life-threatening. 250 years ago, Rabbi Yaakov Emden (1697-1776) ruled6 that "in such cases we allow them to do as they wish without protesting because sometimes they are cured and saved." Nevertheless, he subsequently states: "In any event, people should be concerned about themselves and when there is no danger in the suffering, it is not proper to [undergo dangerous surgery for relief of pain alone]… a person is not permitted to enter into a situation of possible danger, for even though many did so and were saved, many hastened their deaths by such surgery. Therefore, it is not completely permitted."

The consensus among experts in Jewish law is that one should not undergo significant risk for a non-life-threatening condition.

Based upon the above considerations, all opinions would allow our patient to undergo the risky valve replacement if the probability of success is greater than 50%. If the odds were less than 50%, most experts would still allow the surgery, while a few might not. Nevertheless, the consensus of Jewish law is that there is no obligation to undergo very dangerous treatment, even if refusal of the treatment means certain death.

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About the Author

Dr. Daniel Eisenberg is with the Department of Radiology at the Albert Einstein Medical Center in Philadelphia, PA and an Assistant Professor of Diagnostic Imaging at Thomas Jefferson University School of Medicine. He has taught a Jewish medical ethics class for the past 15 years. Dr. Eisenberg writes extensively on topics of Judaism and medicine and lectures internationally on topics in Jewish medical ethics to groups of all backgrounds. Obtain more information on scheduling a lecture or learning more about Jewish medical ethics by visiting Dr. Eisenberg at www.daneisenberg.com

I want to know about the concept of "sin" due to Adam and Eve eating from the Tree of Knowledge. The Christian concept of sin revolves around the fall of the man and the "original sin." Does Judaism view it the same way?

The Aish Rabbi Replies:

Adam and Eve were punished according to their actions. In other words, God laid down the conditions for Adam and Eve to live in the garden, provided they would not eat from the Tree of Knowledge. However, if they were to eat from that tree they would be punished by experiencing death. (If they had not eaten from the tree, they would have remained immortal.)

This sets down the basic principle in Judaism of Reward and Punishment. Basic to this is that every person has the choice of doing good or bad. When a person chooses "good" – as defined by God – he is able to draw close to God. In other words, every individual has a chance to "gain salvation" through his own actions.

My understanding of Christianity, however, is that the Original Sin has infected all of mankind to the point where individuals are incapable of achieving salvation through their own initiative. Man is "totally depraved" and therefore his only hope of salvation is through the cross.

This belief is contrary to the teachings of Judaism. From the Torah perspective, an individual does not need to rely on anyone else to atone for them. In Judaism, sins can be "erased" altogether by sincere repentance and a firm resolution never to repeat the mistakes.

For more on this, read "Their Hollow Inheritances" by Michael Drazin – www.drazin.com

Yahrtzeit of Moses in 1273 BCE (Jewish year 2488), on the same day of his birth 120 years earlier. (Consequently, "May you live to 120" has become a common Jewish blessing.) Moses was born in Egypt at a time when Pharaoh had decreed that all Jewish baby boys be drowned in the Nile River. His mother set him afloat in a reed basket, where he was -- most ironically -- discovered by Pharaoh's daughter and brought to Pharaoh's palace to be raised. When Moses matured, his heart turned to aid the Jewish people; he killed an Egyptian who was beating a Jew, and he fled to Midian where he married and had two sons. God spoke to Moses at the Burning Bush, instructing him to return to Egypt and persuade Pharaoh to "let My people go." Moses led the Jews through the ten plagues, the Exodus, and the splitting of the Red Sea. Seven weeks later, the Jews arrived at Mount Sinai and received the Torah, the only time in human history that an entire nation experienced Divine revelation. Over the next 40 years, Moses led the Jews through wanderings in the desert, and supervised construction of the Tabernacle. Moses died before being allowed to enter the promised Land of Israel. He is regarded as the greatest prophet of all time.

Lack of gratitude is at the root of discontent. In order to be consistently serene, we must master the attribute of being grateful to the Creator for all His gifts. As the Torah (Deuteronomy 26:11) states, "Rejoice with all the good the Almighty has given you." This does not negate our wanting more. But it does mean that we have a constant feeling of gratitude since as long as we are alive, we always have a list of things for which to be grateful.

[Just before Moses' death] God said to him, "This is the Land that I promised to Abraham, to Isaac, and to Jacob" (Deuteronomy 34:4).

The Midrash says that Moses pleaded to live long enough to be able to enter the Promised Land. He surrendered his soul only after God instructed him to enter Heaven and inform the Patriarchs that the Israelites had come to their Land and that God had indeed fulfilled His promise to give the Land of Israel to their descendants. To fulfill God's will was dearer to Moses than his craving to enter the Land.

It is only natural to cling to life, and the thought of leaving this world is depressing. However, if a person develops the attitude that he lives only in order to fulfill God's will, then life and death are no longer polar opposites, because he lives to do the will of God, and when that will requires that he leave this world, he will be equally obedient.

The seventh day of Adar is the anniversary of Moses' death. He wanted to enter the Promised Land so that he could fulfill the commandments and thereby have a new opportunity to fulfill the Divine wish. He surrendered his soul willingly when he was told that there was a special commandment for him to perform, one that could only be achieved after leaving this earth.

We refer to Moses as Rabbeinu, our teacher. He not only taught us didactically, but by means of everything he did in his life - and by his death, as well.

Today I shall...

try to dedicate my life to fulfilling the will of God, so that even when that will contradicts my personal desires, I can accept it with serenity.

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